The Autism Spectrum Disorders
At the completion of this unit the learner will be able to:
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What are the Autism Spectrum Disorders?
Autism Spectrum (ASD) are a range of complex neurodevelopment disorders, characterized by social impairments, communication difficulties, and restricted, repetitive, and stereotyped patterns of behavior. Symptoms generally begin to appear sometimes around six months of age, and become more noticable over the next two to three years. As many as 10% of those with ASD display extraordinary talents relative to the general population, such as the remarkable ability to memorize and recreate objects and landscapes in detailed drawings Stephen Wiltshire Experts estimate that one out of every 91 children will have ASD. Males are four times more likely to have ASD than females. It is often difficult to categorize a child into one of the categories along the spectrum of autistism dosorders.
Disorders in the Spectrum
- Classic Autism
Although the entire spectrum of ASDs are classified as pervasive developmental disorders, classic Autism is characterized by impaired ability to communicate and interact. These children tend to be non-verbal (or nearly so), and desplay compulsive, repetetive behaviors. [1] and severely restricted interests. These children are more likely to have significant learning disabilities and a lower than average IQ, lack the ability to engage with others, and tend perform very poorly on standard diagnostic tests.
- Asperger's Syndrome
Asperger’s Syndrome is felt to be one of the milder forms of ASD as the symptoms experienced tend to be less severe allowing for a higher level of personal and interactive functioning. People with Asperger's tend to have some degree of social isolation due to impairments in two-sided social interaction and non-verbal communication. Their speech may sound peculiar due to abnormalities of inflection and a repetitive pattern. Clumsiness may be prominent both in their articulation and gross motor behavior. They tend to develop focused areas of interest which may leave no space for more age appropriate, common interests.
- Pervasive Developmental Disorder NOS (atypical autism)
Pervasive Developmental Disorder- Not Otherwise Specified (PDD-NOS) is the term used when a person cannot be definitively classified into the classic autism or Asperger's Syndrome categories. characterized by delays in the development of socialization and communication skills. As with classic autism and Asperger's Syndrome, parents may note symptoms as early as infancy, although the typical age of onset is before 3 years of age. Symptoms may include problems with using and understanding language, difficulty relating to people, objects, and events, and unusual play with toys and other objects. Changes in routine or familiar surroundings tend to present difficulty, and repetitive body movements or behavior patterns are common.
- Childhood Disintegrative Disorder
Childhood Disintegrative Disorder is a rare condition characterized by late onset autism type symptoms that may appear over the course of days or months. The symptoms typically appear in a previously normal child after about three years of age, but the child develops sudden and severe loss of previously acquired or learned skills such as speaking and understanding communications, social and self care skills, bowel and bladder control, and motor skills. Repetitive and stereotyped patterns of behavior such as hand flapping, rocking, ritualistic behaviors, and preoccupation with objects or activities are also common.
- Rett Syndrome
Occurring almost exclusively in girls, Rett Syndrome is a severe brain disorder producing symptoms similar to autism. Severity of symptoms differ from child to child but the symptoms typically appear in four stages:
Stage 1: Begin at between 6 and 18 months of age. The child may begin to engage in less eye contact and begin losing interest in toys. They may also have delays in sitting and crawling.
Stage 2: Starting between 1 and 4 years of age, the child will begin to lose the ability to speak and use their hands puposefully. Repetitive motions such as hand wringing and clapping may be noted, and some children will hold their breath, cry out, and scream for no apparent reason. This is often the stage where slowing of head, hand, and feet growth is noted.
Stage 3: This stage begins somewhere between 2 and 10 years of age and is characterized by a plateauing of symptoms. Behavior may improve, with less acting out and improved alertness.
Stage 4: The last stage of Rett's sydrome is marked by decreased mobility, weakness, and development of scoliosis.
Causes of ASDs
Scientists aren’t certain about what causes ASD, but it’s likely that both genetics and environment play a role. Researchers have identified a number of genes associated with the disorder. Studies of people with ASD have found irregularities in several regions of the brain. Studies also suggest that people with ASD have abnormal levels of serotonin or other neurotransmitters in the brain. A significant percentage of people with have DNA alterations in a genetic area that affects how neurons interconnect in the brain.
Twin and family studies strongly suggest that some people have a genetic predisposition to autism. Identical twin studies show that if one twin is affected, there is a 90% chance the other twin will be affected. In families with one child with ASD, the risk of having a second child with the disorder is approximately 5 percent, or one in 20. As evidenced by a long history of family and twin studies, ASDs are the neuropsychiatric disorder most affected by genetic factors.
Diagnosing ASDs
- Very early indicators that require evaluation by an expert
- no babbling or pointing by age 1
- no single words by 16 months or two-word phrases by age 2
- no response to name
- loss of language or social skills
- poor eye contact
- excessive lining up of toys or objects
- no smiling or social responsiveness
- Later indicators
- impaired ability to make friends with peers
- impaired ability to initiate or sustain a conversation with others
- absence or impairment of imaginative and social play
- stereotyped, repetitive, or unusual use of language
- restricted patterns of interest that are abnormal in intensity or focus
- preoccupation with certain objects or subjects
- inflexible adherence to specific routines or rituals.
- Common overall signs
- Impaired social interaction
- Focus intently on one item to the exclusion of others for long periods of time
- Difficulty interpreting what others are thinking or feeling because they can’t understand social cues
- May lack empathy
- Many children with ASD engage in repetitive movements such as rocking and twirling, or in self-abusive behavior such as biting or head-banging.
- Tend to start speaking later than other children and may refer to themselves by name instead of “I” or “me.”
- Don’t know how to play interactively with other children.
- Some speak in a sing-song voice about a narrow range of favorite topics, with little regard for the interests of the person to whom they are speaking.
ASD Comorbidities
- Children with ASD appear to have a higher than normal risk for certain co-occurring conditions, including Fragile X syndrome (which causes mental retardation), tuberous sclerosis (in which tumors grow on the brain), epileptic seizures, Tourette syndrome, learning disabilities, and attention deficit disorder
- About 20 to 30 percent of children with ASD develop epilepsy by the time they reach adulthood.
- Children whose language skills regress early in life (before the age of 3) appear to have a higher than normal risk of developing epilepsy or seizure-like brain activity.
- Evidence shows that up to 80% of children with ASD suffer from celiac disorders
Treating ASDs
| Jason McElwain, diagnosed with high functioning autism, acted as team manager for his high school basketball team until the last game of the season. |
There is no cure for ASDs and there is no one known treatment that works for every person affected by ASDs. Depending on the ASD manifestations a person may display, treatment options may include:
- Behavior and communication therapies
Speech, occupational, and physical therapies are widely used in the treatment of ASDs to help with language, social, and motor skills acquisition. Evidence has shown that the most effective method of treating issues around behavior and communication is the use of milieu therapy, a method that involves teaching stadardized and repetitive modifying behaviors in the home as well as the classroom in order to promote generalization of the behaviors in all experienced environments.
- Education therapies
Children with ASDs tend to respond well to highly structured environments and educational strategies. LEGO therapy has been shown to be highly effective because children with ASD are so naturally drawm to systems creation. Just as staking and lining up items seems as if it calms the child with ASD, building structures with LEGOs along with the child while encouraging response to and initiation of communication during the building process has proven to be a highl effective educational, behavioral, and communication intervention strategy.
- Drug therapies
There are no drugs that directly treat ASDs but certain symptoms such as severe behavior problems, repetitive movements, seizures, and depression can be treated effectively with drug therapy.
Alternative Therapies
Although studies have not been able to confirm or deny the effectiveness of some of the "alternative" therapies, many families have reported possitive results from the following:
- Creative therapies
Some parents have found that art and/or music therapy are effective in focusing and calming their autistic children.
- Special diets
Identifying food allergies and sensitivities has reportedly been effective in treating autism symptoms. The most common and purportedly effective diet regimen employed by parents is the gluten (grain protein) free, cassein (milk protein) free diet. Other therapies include limiting yeasts, including probiotics in the diet, and the use of dietary supplements.
- Chelation therapy
There is speculation by some that mercury (included in extremely small amounts in vaccines) may have some effect on children with autism. Chelation therapy removes mercury and other hard metals from the body. However, there is no evidence showing the effectiveness of this therapy.
Challenges in the Lives of Those Affected by ASDs
| Families affected by ASDs discuss the difficulties and social stigmas they encounter. |
Challenges are inherent in raising all children- it's difficult to know if what we're doing is best for our children, but this concern is magnified when you are the parent of av child with ASD. There is so little research based evidence for best practices in caring for the child with ASD. Knowledge is power though, and there are many resources available (see Web Resources below).
One of the most challenging aspects of ASD are the behaviors that many children with ASD display. Acting out, repetitive behaviors, and lack of "normal" social skills can lead to peer rejection, for both the child and the family. Learning to modify the behaviors and joining support groups are excellent strategies to address these challenges.
